MatrixNEURO. The next generation cranial plating system.

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1 MatrixNEURO. The next generation cranial plating system. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.

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3 Table of Contents Introduction MatrixNEURO 2 Intended Use, Indications, Contraindications, General Adverse Events, and MRI Information 4 Surgical Technique 5 Product Information Ordering Information 10 Image intensifier control Warning This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: MatrixNEURO Surgical Technique DePuy Synthes 1

4 MatrixNEURO Introduction The aim of surgical fracture treatment is to reconstruct the bony anatomy and restore its function. According to the AO, internal fixation is distinguished by anatomical reduction, stable fixation, preservation of blood supply, and early, active mobilization. Plate and screw osteosynthesis has been established and clinically recognized for some time. Keeping the AO philosophy at its core, Matrix is the new plating platform for internal fixation of the cranio-maxillofacial skeleton addressing neuro, craniofacial, mandibular, and orthognathic surgery. Matrix is a simple yet comprehensive system that offers flexibility and ease of use. All screws work with all plates within each Matrix system One blade for all screws within each Matrix system Reduced plate/screw profile, where applicable Self-retaining screws/blades that minimize cam-out Standardized instrumentation Color-coding by strength for easy identification Rounded edges on plates for less irritation to soft tissue, where applicable Reduced inventory for hospitals without compromising clinical solutions 2 DePuy Synthes MatrixNEURO Surgical Technique

5 MatrixNEURO Cranial Plating System Self-drilling screws for fast closure of bone flaps and rapid fixation of cranial fractures Wide variety of screws, plates and mesh allows the surgeon to select the most appropriate implants based upon patient needs Plate/screw profile Ultra Low Profile Plates (green): Plate thickness = 0.3 mm, Plate/Screw profile = 0.4 mm Standard Plates (blue): Plate thickness = 0.4 mm, Plate/Screw profile = 0.5 mm Malleable (silver) and Rigid (blue) Mesh: Mesh thickness = 0.4 mm, Plate/Mesh profile = 0.5 mm Extra Rigid Mesh (pink): Mesh thickness = 0.6 mm, Plate/Mesh profile = 0.9 mm Emergency screw Self-drilling screw MatrixNEURO Self-drilling Screws Thread design for rapid screw starting and low insertion torque* Available in 3 lengths: 3 mm, 4 mm and 5 mm MatrixNEURO Plates Full selection of titanium plates and burr hole covers Standard Plates Ultra Low Profile Plates MatrixNEURO Contourable Meshes Available in a variety of shapes and sizes Color-coded based on strength characteristic: Silver (0.4 mm thick, malleable) Blue (0.4 mm thick, rigid) Pink (0.6 mm thick, extra rigid) Malleable Mesh Extra Rigid Mesh Rigid Mesh Strength Gradient 0.4 mm 0.4 mm 0.6 mm Malleable Rigid Extra Rigid * Mechanical test data on file at Synthes. MatrixNEURO Surgical Technique DePuy Synthes 3

6 Intended Use, Indications, Contraindications, and MRI Information Intended Use For cranial closure and/or bone fixation. Indications For use in the following indications: craniotomies, cranial trauma repair and reconstruction. Contraindications Use in areas with active or latent infection or insufficient quantity or quality of bone. General Adverse Events As with all major surgical procedures, risks, side effects and adverse events can occur. While many possible reactions may occur, some of the most common include: Problems resulting from anesthesia and patient positioning (e.g. nausea, vomiting, neurological impairments, etc.), thrombosis, embolism, infection or injury of other critical structures including blood vessels, excessive bleeding, damage to soft tissues incl. swelling, abnormal scar formation, functional impairment of the musculoskeletal system, pain, discomfort or abnormal sensation due to the presence of the device, allergy or hyperreactions, side effects associated with hardware prominence, loosening, bending, or breakage of the device, mal-union, non-union or delayed union which may lead to breakage of the implant, reoperation. Warnings: The MatrixNEURO fixation system is not intended for use in patients who are not yet skeletally mature. Resorbable fixation products should be considered as an alternative. These devices can break during use (when subjected to excessive forces or outside the recommended surgical technique). While the surgeon has to make the final decision on removal of the broken part based on associated risks in doing so, we recommend that whenever possible and practical for the individual patient, the broken part be removed. Be aware that implants are not as strong as native bone. Implants subjected to substantial loads may fail. Medical devices containing stainless steel may elicit an allergic reaction in patients with hypersensitivity to nickel. MRI Information Torque, Displacement and Image Artifacts according to ASTM F , ASTM F e1 and ASTM F Non-clinical testing of a worst case scenario in a 3 T MRI system did not reveal any relevant torque or displacement of the construct for an experimentally measured local spatial gradient of the magnetic field of 5.4 T/m. The largest image artifact extended approximately 34 mm from the construct when scanned using the Gradient Echo (GE). Testing was conducted on a 3 T MRI system. Radio-Frequency-(RF-)induced heating according to ASTM F a Non-clinical electromagnetic and thermal simulations of a worst case scenario lead to temperature rises of 10.7 C (1.5 T) and 8.0 C (3 T) under MRI Conditions using RF Coils (whole body averaged specific absorption rate [SAR] of 2 W/kg for 15 minutes). Precautions: The above mentioned test relies on non- clinical testing. The actual temperature rise in the patient will depend on a variety of factors beyond the SAR and time of RF application. Thus, it is recommended to pay particular attention to the following points: It is recommended to thoroughly monitor patients undergoing MR scanning for perceived temperature and/or pain sensations. Patients with impaired thermo regulation or temperature sensation should be excluded from MR scanning procedures. Generally it is recommended to use an MRI system with low field strength in the presence of conductive implants. The employed specific absorption rate (SAR) should be reduced as far as possible. Using the ventilation system may further contribute to reduce temperature increase in the body. 4 DePuy Synthes MatrixNEURO Surgical Technique

7 Surgical Technique 1 Select Implant Select the appropriate implants listed in the ordering information section on pages 10 and 11. The MatrixNEURO Plate and Screw system contains a wide variety of plates, burr hole covers, mesh and screws. 2 Size implant (if required) Instruments Cutting Scissors for Mesh Plates, short Cutting Scissors for Mesh Plates, long The implants may be cut and sized to match the patient anatomy and the needs of the specific case. Precautions: Take care to protect soft tissue from trimmed edges. Replace worn or damaged cutting instruments if the cutting function is not adequate. Cut the implant immediately adjacent to the screw holes. MatrixNEURO Surgical Technique DePuy Synthes 5

8 Surgical Technique 3 Contour implant (if required) Instruments Plate Bender, locking Plate Bender, non-locking The implant can be further contoured to match patient anatomy. Precautions: Avoid contouring of the implant in situ as that may lead to implant malposition. Excessive and repetitive bending of the implant increases the risk of implant breakage. After implant placement is complete, discard any fragments or modified parts in an approved container. 4 Position implant Instruments Plate Holder, short Plate Holder, long Position the implant on the desired location using the appropriate plate holder. 6 DePuy Synthes MatrixNEURO Surgical Technique

9 Precaution: When using plates, ensure countersink holes are facing upwards. 5 Pre-drill screw holes (optional) Instruments Drill Bit B 1.1 mm with Stop, 4 mm, for J-Latch Coupling Drill Bit B 1.1 mm with Stop, 4 mm, for Hex Coupling Precautions: Predrill in dense bone when using 5 mm screws. Use only a 1.1 mm drill bit for pre-drilling. Drill speed rate should never exceed 1,800 rpm, particularly in dense, hard bone. Higher drill speed rates can result in: thermal necrosis of the bone, soft tissue burns, an oversized hole, which can lead to reduced pullout force, increased ease of the screws stripping in bone, suboptimal fixation, and/or the need for emergency screws. Avoid damaging the plate threads with the drill. Always irrigate during drilling to avoid thermal damage to the bone. Irrigate and apply suction for removal of debris potentially generated during implantation or removal. MatrixNEURO Surgical Technique DePuy Synthes 7

10 Surgical Technique 6 Secure implant Instruments Screwdriver handle, small Screwdriver handle, medium Screwdriver handle, large Screwdriver shaft, short Screwdriver shaft, medium Insert MatrixNEURO self-drilling Screws B 1.5 mm to secure the implants. If the self-drilling screw does not retain good purchase, replace it with a 1.8 mm emergency screw of the same length. Note: Screwdriver shafts are self-retaining instruments. Please replace worn or damaged screwdriver shafts, if the retention is not adequate. Precautions: Fully engage the shaft perpendicular to the screw head. Place the 1.5 mm self-drilling screw perpendicular to the bone at the appropriate plate hole. Consider an appropriate length of screw to avoid injury of underlying structure with too long screws or plate loosening and/or migration with too short screws. Take care not to overtighten the screw. In order to determine the appropriate amount of fixation for stability, the surgeon should consider the size and shape of the fracture or osteotomy. DePuy Synthes recommends at least three plates with an appropriate number of screws when repairing osteotomies. Additional fixation is recommended to ensure stability of large fractures and osteotomies. When using mesh for larger defects, additional screws for fixation are recommended. After implant placement is complete, irrigate and apply suction for removal of debris potentially generated during implantation. 8 DePuy Synthes MatrixNEURO Surgical Technique

11 Technique Tip Before positioning the bone flap on the patient, it is advantageous to secure the implants to the bone flap first Secure the desired plates to bone flap. 2. Position the bone flap on the patient. 3. Secure the plates to the skull. 2 3 MatrixNEURO Surgical Technique DePuy Synthes 9

12 Ordering Information Sets MatrixNEURO Basic Set MatrixNEURO Standard Set MatrixNEURO Basic Instrument Set MatrixNEURO Standard Instrument Set incl. Insert for Mesh Plates MatrixNEURO Set for use with sterile implants Modules Module MatrixNEURO, 1/3, Basic, with Lid, without Contents Module for Plates and Screws, for MatrixNEURO, size 1/2, with Lid Instrument Tray, 1/3, Basic and Labelling Clips for Instrument Tray MatrixNEURO, Standard Instrument Tray for Low Profile Neuro and MatrixNEURO System, size 1/2, with Lid Instrument Tray for MatrixNEURO Reconstruction Mesh Plates Module for use with sterile implants, without Lid and Labelling Clips for Module for use with sterile implants Lid MatrixNEURO for No Vario Case, Framing, size 1/2, height 88 mm Lid (Stainless Steel), size 1/2, for Vario Case MatrixNEURO Screws, Titanium Alloy (TAN), self-drilling (silver)* C C C C C C Screw B 1.5 mm, length 3 mm, pack of 1 unit in Clip Screw B 1.5 mm, length 3 mm, pack of 4 units in Clip Screw B 1.5 mm, length 4 mm, pack of 1 unit in Clip Screw B 1.5 mm, length 4 mm, pack of 4 units in Clip Screw B 1.5 mm, length 5 mm, pack of 1 unit in Clip Screw B 1.5 mm, length 5 mm, pack of 4 units in Clip MatrixNEURO Emergency scews, Titanium Alloy (TAN), self-tapping (blue)* C C C MatrixNEURO Sterile Kits Emergency Screw B 1.8 mm, length 3 mm, pack of 1 unit in Clip Emergency Screw B 1.8 mm, length 4 mm, pack of 1 unit in Clip Emergency Screw B 1.8 mm, length 5 mm, pack of 1 unit in Clip S Standard, 4 mm (contains: 6 ref C + 3 ref ) S Burr Hole Cover, 17 mm (contains: 8 ref C + 2 ref ) MatrixNEURO Plates, thickness 0.4 mm, Pure Titanium* Strut Plate, contourable Temporal Mesh Plate, contourable Cranial Plate, straight, with centre space, 9 mm, 2 holes Cranial Plate, straight, with centre space, 12 mm, 2 holes Cranial Plate, straight, with centre space, 12 mm, 4 holes X-Plate, 4 holes Frame Plate, square, 4 holes, mm Frame Plate, square, 4 holes, mm Y-Plate, 5 holes Double-Y-Plate, 6 holes, length 18 mm Double-Y-Plate, 6 holes, length 21 mm Adaption Plate, 5 holes Adaption Plate, 7 holes Adaption Plate, 20 holes Frame Plate, rectangular, 4 holes, mm Strut Plate, 2 3 holes, mm Strut Plate, 2 4 holes, mm MatrixNEURO Ultra Low Profile Plates, thickness 0.3 mm, Pure Titanium* Cranial Plate, straight, with centre space 9 mm, 2 holes Cranial Plate, straight, with centre space 12 mm, 2 holes Cranial Plate, straight, with centre space 12 mm, 4 holes X-Plate, 4 holes Frame Plate, square, 4 holes, mm Double-Y-Plate, 6 holes, length 18 mm Frame Plate, rectangular, 4 holes, mm Strut Plate, 2 3 holes, mm MatrixNEURO Burr Hole Covers, thickness 0.4 mm, Pure Titanium* B 12.0 mm B 15.0 mm B 17.0 mm B 24.0 mm B 12.0 mm, for Shunt or Drainage B 15.0 mm, for Shunt or Drainage B 17.0 mm, for Shunt or Drainage B 24.0 mm, for Shunt or Drainage MatrixNEURO Ultra Low Profile Burr Hole Covers, thickness 0.3 mm, Pure Titanium (green)* B 12.0 mm B 15.0 mm B 17.0 mm B 24.0 mm B 17.0 mm, for Shunt or Drainage 11 DePuy Synthes MatrixNEURO Surgical Technique

13 MatrixNEURO Contourable Mesh, Pure Titanium* mm, malleable mm, rigid mm, malleable mm, rigid mm, rigid Crescent-shaped, small, malleable Crescent-shaped, large, malleable Crescent-shaped, small, rigid Crescent-shaped, large, rigid Circular, B 30 mm, malleable Circular, B 70 mm, malleable Circular, B 100 mm, malleable Circular, B 30 mm, rigid Circular, B 70 mm, rigid Circular, B 100 mm, rigid Mastoid Plate, small Mastoid Plate, medium Mastoid Plate, large mm, thickness 0.6 mm,extra rigid mm, thickness 0.6 mm, extra rigid mm, thickness 0.6 mm,extra rigid crescent-shaped, small, thickness 0.6 mm, extra rigid crescent-shaped, large, thickness 0.6 mm, extra rigid circular, B 30 mm, thickness 0.6 mm, extra rigid circular, B 70 mm, thickness 0.6 mm, extra rigid circular, B 100 mm, thickness 0.6 mm, extra rigid Instruments Screwdriver Shaft 1.5, short, for Hex Coupling Screwdriver Shaft 1.5, medium, for Hex Coupling Plate Bender, locking Plate Bender, non-locking Plate Holder, short Plate Holder, long Cutting Scissors for Mesh Plates, short Cutting Scissors for Mesh Plates, long Drill Bit B 1.1 mm with Stop, 4 mm, for J-Latch Coupling Drill Bit B 1.1 mm with Stop, 4 mm, for Hex Coupling Screwdriver handle, small, with hex coupling Screwdriver handle, medium, with hex coupling Screwdriver handle, large, with hex coupling * For sterile screws and plates add suffix S to article number. For label clips add suffix LC to article number. Color of the meshes Extra rigid = pink Rigid = blue Malleable = silver Color of the plates MatrixNEURO 0.4 mm = blue MatrixNEURO Ultra Low Profile 0.3 mm = green MatrixNEURO Surgical Technique DePuy Synthes 11

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16 DSEM/CMF/0614/0016(1) 09/15 Synthes GmbH Eimattstrasse Oberdorf Switzerland Tel: Fax: This publication is not intended for distribution in the USA. All surgical techniques are available as PDF files at DePuy Synthes CMF, a division of Synthes GmbH All rights reserved